ABSTRACT
The aim of this study was to estimate the effectiveness of different mono- and combination therapies with catecholamines (dopamine, dobutamine, adrenaline and noradrenaline) in the treatment of low cardiac output syndrome after open-heart surgery. All together 425 patients treated at the Intensive Care Unit of the Clinic for Anaesthesiology and Intensive Care Therapy of the Martin Luther University Halle-Wittenberg after open-heart surgery from 1985-1986 were examined. The low cardiac output syndromes were characterised by the following parameters: mean arterial pressure (MAP), heart frequency (HF), central venous pressure (CVP), diuresis and mixed venous oxygen saturation (SvO2). Recommendations were given for evaluating the grade of low cardiac output syndrome and for selecting whether a mono- or a combination therapy is necessary and which dose should be given. Thus, the pretherapeutical signs MAP 50 mm Hg and presence of 3 disturbed signs characterise severe low cardiac output syndrome and make necessary the primary combined application of catecholamines. Two investigated signs connected in a mathematical formula can help to determine when during a low-cardiac output state a dopamine-monotherapy should be replaced by a combination therapy of catecholamines. It was found, that the doses of dopamine increased proportionally to the reached level of catecholamine combination. Therefore, doses of catecholamines should be kept in their recommended range with their specific receptor-mediated effect.
